Skin Care for Infants
The following article can be found in Understanding Your Child’s Health by Susan K Schulman MD., which will be available in July, 2009 (Hamodia Treasures, distributed by Israel Book Shop)
The skin is a very remarkable organ in the human body. Although it often goes unnoticed, it performs a variety of jobs. It is the vital protective wrapping for all of the body’s structures. As it covers bones, muscles, blood vessels, and internal organs, it helps maintain body temperature and hydration. Through the sweat mechanism it also plays a role in the maintenance of the salt balance in the body.
Pigment production helps defend the body from harmful sunburn. The intact skin barrier prevents infection by bacteria, parasites, fungi and some viruses. The sensitive nerve endings on the skin give essential signals to the brain about the environment such as temperature, humidity and texture. Proper care of the skin is essential to everyone’s health and comfort. Immature skin is very thin and vulnerable so infants and babies need the most careful skin care.
Key points
- Babies have thin delicate skin
- Birthmarks are caused by little blood vessels (blue or red)
- or extra pigment(tan or brown)
- Sunscreens are not effective – use shade and clothing in the sun
- Eczema is often caused by a food allergy
- Yeast often invades the irritated diaper area
Newborn Infants
Very young infants have very delicate skin. Preemies have paper-thin skin that breaks down from the slightest friction. Full-term newborns have skin that is less than 1/3 the thickness of that of an adult. This means that it is more prone to sunburn, irritation in the diaper area, and other rashes.
There are different skin types which are determined by the types of skin that the parents have. Babies with darker hair and complexions are less delicate than blond or red-haired infants, who have fair complexions.
Sun protection. All newborns must be kept in the shade on sunny days. This means long sleeves, covered legs and feet, or a good umbrella. Sunscreens are not effective on such thin skin.
Birthmarks. In the newborn period birth marks often appear on the skin. If these birthmarks appear blue or red, they are caused by clusters of blood vessels in the skin. The most common red ones are on the eyelids, nose, lips and the back of the head. These are called flame nevi. They are usually gone by the first birthday.
The ones identified as “strawberry hemangiomas” often grow thicker and larger with time. Massaging the mark several times a day will often prevent the hemangioma from growing thicker, . If they are very large or if they cover the eyes, they need medical attention. Laser treatment is often therapeutic.
Brown or tan marks are caused by pigments in the skin. These do not always appear at birth, but once they appear they are usually permanent. Light ones never need to be removed. Very dark ones that are also large must be monitored as the baby grows. Some of them will have to be removed in adolescence.
Newborn skin problems
The most common skin problems in newborns are diaper rashes, baby acne, and cradle cap.
Diaper rash. Newborns have frequent and loose bowel movements, which can easily irritate their skin. Soiled diapers should be changed as soon as they are detected. (Urine alone is rarely irritating because of the new gel technology in disposable diapers.)
If a baby soils his diaper during sleep or is inadvertently left in a soiled diaper too long, the skin can become red. This contact rash can be both prevented and treated by using a barrier to keep the skin from being further irritated while it is healing. After a bowel movement, the skin should always be cleaned with either a little water or lotion on a tissue, or baby wipes. Very sensitive skin can be irritated by the chemicals in the wipes or even the chemicals in the diaper. When this happens, changing brands often helps. I have found that the 7Generations brand sold in Babies r Us is very helpful.
In baby boys, a cornstarch-based powder applied to the area before closing the diaper works very well. In baby girls, using powder is not a good idea. The powder gets inside the genital area and can cause a problem. A cream is needed. Most barrier creams have either a white zinc oxide base or a clear petroleum jelly base. All of these provide protection but some seem to work better than others. Do not use Desitin on baby girls because there is powder mixed into the cream.
If the treatment is not effective and the diaper rash develops pimples or dots, or if the skin breaks down, a doctor should be consulted. Sometimes a medicated cream is needed.
Baby acne. Baby acne appears on the baby’s face at around one month of age.. This pimply red rash usually goes away on its own over time. The use of an antifungal cream such as Spectazole will sometimes be needed in very severe cases to get rid of the yeast (not the one that causes thrush) that causes this common problem.
Cradle cap is the accumulation of a greasy, scaly substance on the scalp and forehead. The old-fashioned method of applying oil or Vaseline to the scales and scrubbing the scalp an hour later with a washcloth and baby shampoo works well. A comb can be used to scrape the oiled scales off gently. If the problem is persistent, dandruff shampoos can be used. The scales are sometimes invaded by the same yeast that causes baby acne, and using antifungal shampoo can help. Occasionally, application of 1-percent hydrocortisone cream is needed.
Bathing. The question of how often to bathe a newborn and what to use for soap often comes up. It is generally felt that too much bathing can dry the skin and cause cracking and peeling. Most of the time, 2-3 baths a week are enough for a newborn. The soap used should be fatty, like unscented Dove. The “baby bath” liquids are not really good for the skin. After bathing and wrapping and patting (not rubbing) the skin with a towel, a lotion could be applied while the skin is still a little damp. This traps the water back into the outer layers of skin. Sensitive skin needs unscented and uncolored lotion. . Applying oil all over the skin is not a good idea since many babies break out from the occlusion of the pores.
Heat rash– this rash of tiny raised papules occurs on the neck , chest , and upper back when the baby has been sweating. Gently spreading cornstarch on the rash is helpful. To prevent this problem do not overdress the infant and keep him in a cool shady environment.
Older Babies
After the first 3 months of life the baby’s skin is less delicate, but there are certain problems that become more evident. The most common ones are eczema and chronic diaper rashes.
Eczema. Eczema is an itchy rash that appears as patches of reddened skin which is dry and breaks down. The cause is not always known, but 70 percent of the time it is an allergy to a particular food in the child’s diet. The most common foods that can cause eczema are cow’s milk, egg whites, soy, peanuts, tree nuts, and fish. Infant formulas are based on either milk or soy. In formula fed infant the offending food is milk or soy. The mother’s milk sometimes exposes babies to all of the foods in the mother’s diet.
Changing the type of formula or altering the diet of the baby or the nursing mother to remove all or some of the problem foods often clears up the eczema. Once a problem food is identified, it should be stopped for about 6 months and then tried again. Most food allergies disappear by that time.
Treating eczema
There are differing opinions as to how to treat eczema. The “dry” method advises little or no contact with water and the application of Cetaphyl lotion to clean the skin. The “wet” method is to use water to soften the skin and then to apply moisturizer.
One of the most effective “wet” methods of treating dry skin with eczema is to give daily 20-minute baths followed by the application of lotion while the skin is still damp. Any area that is particularly red or itchy is rubbed with 1-percent hydrocortisone ointment 2-3 times a day until it improves. If the eczema starts to weep and crust, an antibiotic ointment may be needed. Adding two tablespoons of bleach to the bath water and soaking for 20 minutes can help remove the invasive bacteria and prevent infection. Eczema that is more severe needs to be treated by a physician.
Chronic diaper rashes
Most diaper rashes are caused by contact sensitivities. The more persistent rashes that do not clear up with barrier creams and powders are probably invaded by the yeast called Monilia. Yeasts love to grow in moist skin, so the most vulnerable areas are the diaper area and the places where skin folds on skin, such as the chubby creases in the groin and under the chin.
Monilial rashes usually have solid red areas with satellite dots in the periphery. Powder helps to keep the creases dry, but often a medicated cream is needed. Chlortrimazole is very effective in most cases.
If the baby’s stools are very loose and the diaper area is red, sometimes a probiotic such as Culturelle, ½ capsule once a day, or Florastor, one packet two times a day, will improve the stools and help to clear up the rash.
Any rash that does not improve with these basic measures should be checked by a physician.